Mesonephric-Like Adenocarcinomas a Rare Tumor: The Importance of Diagnosis

Abstract

Mesonephric-like adenocarcinomas (MLA) are rare neoplasms that arise in the uterine body and ovary and have been added to the World Health Organisation’s recent 2020 classification of female genital cancers. The pathogenesis of MLA is unknown and it remains debated whether they represent mesonephric carcinomas (Wolffian) arising in the endometrium/ovary or endometrioid carcinomas (Müllerian) closely mimicking mesonephric carcinomas. Here we report the case of a 57-year-old woman with an initial misdiagnosis of endometrioid adenocarcinoma on diagnostic biopsy. The patient came to our clinical evaluation for the appearance of menometrorrhagia complicated by anemia for several months. Therefore, she underwent pelvic echo-flowmetry, with indication for diagnostic hysteroscopy with endometrial biopsy, which yielded a positive result for endometrioid endometrial adenocarcinoma. Following staging CT scan and targeted examinations on pulmonary findings, the patient underwent surgery with surprise of definitive diagnosis deponent for endometrial MLA. Our intention is to establish a brief review of the scientific evidence in the literature and the tools available for a correct histological diagnosis, in the light of the scant anatomopathological evidence. Our question gives rise to the motive for the publication: is immunohistochemistry the right way to resolve the diagnostic error at histology, which is usually the only source of diagnostic certainty? This case is intended to alert of diagnostic error that risked having the patient treated as a neoplasm with a favorable prognosis and low degree of aggressiveness instead of for a very aggressive and poor prognosis tumor such as MLA.

Mesonephric-like adenocarcinoma arising from endometrioid adenofibroma in a patient with in-utero exposure to diethylstilbestrol: A case report

“…As of 2020, only 11 cases had been published, according to an English-language database search. As of today, the number is still less than 20 [ 2 , [5] , [6] , [7] , [8] , [9] ]. Of these cases, none reported a history of patient in-utero exposure to DES.…”

Comprehensive Immunohistochemical Analysis of Mesonephric Marker Expression in Low-grade Endometrial Endometrioid Carcinoma

“…Uterine MLA exhibits a variety of architectural patterns within the same tumor; as a result, it can be misdiagnosed as low-grade EEC, serous carcinoma, or carcinosarcoma 6 . The clinical manifestations, histologic features, immunostaining results, and molecular characteristics of uterine MLA, as well as the difficulty in distinguishing them from other histologic types of EC, have been consistently reported in the literature 2,7–18 . Uterine MLA exhibits more aggressive clinical behavior and worse prognoses than EEC 5,9,13 .…”